Buspirone-induced mania: Possible interaction with disulfiram

unfounded, as at no stage during our involvement with this lady did she demonstrate any affective symptoms whatsoever. Instead she demonstrated the typical featuresof anorexia nervosa, as definedby the DSM—III—R criteria, of severe weight loss, a typical distortion of body image, and a fear of becoming fat. Amenorrhoea was obviously not of relevance because of her advanced age. Although it is difficult to be certain of the exact circumstances surrounding her first episode fifty years beforehand, her account, confirmed by that of other family members, is strongly indicative of anorexia nervosa, and gives no cause to promote an alternativediagnosis. Reports of eating disorders in the elderly are not restricted to that of Bernstein (1972), which O'Shea rightly questions. We have reviewed sixteen cases of anorexia nervosa or bulimia nervosa in the over fifties reported in the recent literature (Cosford & Arnold, submitted), and found serious doubt regard ing the diagnosis in only four. The remaining twelve demonstrated the typical psychopathology of an eat ing disorder, apart from the patient's age. Interest ingly, half had arisen for the first time in later life, while the other half had initially arisen in the patient's youth, and they eitherremainedpersistently unwell for many years, or suffered a relapsing and remitting course, with remissions of up to fifty years in some cases. It is our assertion that advanced age should not by itself ruleout thediagnosis of anorexianervosa, when the typical features are undoubtedly present, and there is no alternative major physical or psychiatric cause for the patient's symptoms.